ABSTRACT Introduction and objectives: The diagnostic test of COVID-19 with the highest sensitivity is a nasopharyngeal sample using a swab for subsequent study using RT-PCR. The objective of our work is to explain in detail the most appropriate way to perform this technique. Material and methods: We present a retrospective study of 17 patients. Finally, two patients were excluded. The patients were 34-72 years old. A Polysomnography was done, and hypopneaapnea index was 7,32±8,71. Discussion and conclusions: This a secure technique and can be reproduced in all ENT services. DISE less us individualize chirurgical treatment and avoid us unnecessary patients' operations.

RESUMEN Introducción y objetivos: Somnoscopy can Valore the possible obstruction in superior aerodigestive tract, that lead to obstructive sleep apnea syndrome (OSAS). Our objective is showing our experience using the somnoscopy or DISE (drug induced sleep endoscopy). Material y métodos: Presentamos un estudio retrospectivo de 17 pacientes de los que se excluyen finalmente 2. La edad de los pacientes varió de 34 a 72 años. Se practica polisomnografía previa y el IAH medio fue 7,32±8,71. Discusión y conclusión: La DISE es una técnica segura, reproducible y aplicable en cualquier servicio de ORL. Así mismo, permite individualizar el tratamiento quirúrgico y probablemente evitar cirugías innecesarias.

INTRODUCTION: Mesoamerican nephropathy, also known as chronic kidney disease of unknown etiology, is widespread in Pacific coastal Central America. The cause of the epidemic is unknown, but the disease may be linked to multiple factors, including diet as well as environmental and occupational exposures. As many as 50% of men in some communities have Mesoamerican nephropathy. OBJECTIVE: Describe prevalence of reduced glomerular filtration rate in a region of Nicaragua suspected to harbor high rates of Mesoamerican nephropathy; and investigate potential risk factors for such reduction associated with agricultural work (such as pesticide exposure and specific agricultural tasks associated with increased heat stress); sugar consumption; and traditional factors such as age, sex, diabetes, hypertension and nephrotoxic medication use. METHODS: This study uses a cross-sectional design with nested case-control analysis. Cases were individuals with estimated glomerular filtration rates of <60mL/min/1.73m² and controls were individuals with those >90mL/min/1.73m², estimated using serum creatinine. Data on nutrition, past medical history, medication and substance use, and agricultural behaviors and exposures were collected using medical questionnaires from June through August, 2012. Venous blood and urine samples were collected to assess hemoglobin A1c, and dipstick proteinuria, respectively; anthropometry and blood pressure measurements were made using standard techniques. Analyses were conducted using chi square, and univariate and multiple logistic regression. RESULTS: Of 424 individuals in the study, 151 had an occupational history in agriculture. Prevalence of glomerular filtration rate <60mL/min/1.73m² was 9.8% among women and 41.9% among men (male to female ratio = 4.3, p<0.0001). Proteinuria ≥300 mg/dL was observed in <10% of participants with decreased glomerular filtration rate. Hemoglobin A1c and use of NSAIDs were not associated with decreased glomerular filtration rate. Although systolic and diastolic blood pressure was higher among participants with decreased glomerular filtration rate (p <0.001), hypertension was uncommon. Significant agricultural risk factors for reduced glomerular filtration rate included increased lifetime days cutting sugarcane during the dry season (OR 5.86, 95% CI 2.45 - 14.01), nondeliberate pesticide inhalation (OR 3.31, 95% CI 1.32 - 8.31), and sugarcane chewing (OR 3.24, 95% CI 1.39 - 7.58). CONCLUSIONS: Our findings demonstrate a high prevalence of chronic kidney disease not linked to traditional risk factors, and suggest it may be associated instead with occupational exposure to heat stress in conjunction with pesticide inhalation, sugarcane chewing and sugar intake during the workday.